Project Summary Nicaragua is a low-income country where epidemiological and nutrition transitions have taken hold. Non- communicable diseases (NCDs) now account for 73% of all deaths, with cardiovascular diseases topping the list. As in other low- and middle-income countries (LMICs), prevention of NCDs is key to addressing this health crisis, given the limited health sector and family-based resources available to treat NCDs. Yet the recent research and policy efforts addressing NCDs in Nicaragua have focused on describing the rates and the need to treat NCDs in the adult population, with little attention to social and economic predictors of NCD risk factors or earlier life course stages. Adolescence is a period of the life course involving the adoption of risky health behaviors and the onset of health conditions related to multiple NCDs. It is critical that we understand the social contexts associated with NCD risk factors in this stage preceding adulthood. Further, Nicaragua has one of the highest adolescent birth rates in the region, suggesting that NCD risk factors may be biologically embedded through births at this stage, contributing to future increases in NCDs in Nicaragua. We propose capacity-building research by working with a local research organization, the Center for Demographic and Health Research (CIDS), in Len, Nicaragua, to implement a longitudinal, population-based study of social/economic insecurities, stress and NCD risk factors among adolescents and their caregivers. This study builds on an existing cohort of almost 500 children and caregivers interviewed in 2012, to provide a new focus on NCD-related risk factors emerging as the children enter adolescence. Key risk factors at this stage include substance use, poor mental health, high BMI in adolescence. We will follow up with caregivers as well to determine changes in their NCD health risks over the 7-year period. Further, we will determine the role of chronic stress in the development of NCD risk factors by assessing psychosocial stress in adolescents and their caregivers and collecting a novel physiological marker of chronic stress exposure?hair cortisol?in adolescents. Through joint research and capacity building efforts, CIDS will develop their electronic data collection and statistical analysis abilities, which will be applied in this study and the development of future NCD research in Nicaragua.